Added Value of Live 3-Dimensional Transesophageal Echocardiography During Procedures in Fontan Patients
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ORIGINAL ARTICLE
Added Value of Live 3‑Dimensional Transesophageal Echocardiography During Procedures in Fontan Patients S. Javed Zaidi1,2 · Jamie Penk1 · Lorene Schweig1 · Vivian W. Cui1 · Waseem Cossor1 · David A. Roberson1 Received: 20 January 2020 / Accepted: 27 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 3D transesophageal echocardiography (3D-TEE) has proven useful and accurate during some operating room (OR), interventional cardiac catheterization (Cath), and electrophysiologic (EP) procedures. The use of 3D-TEE during similar procedures in patients who have undergone Fontan surgery and its additional value have not been previously reported. To determine if live 3D-TEE during procedures post Fontan has added value, 3D-TEEs in 58 post-Fontan patients over a 5-year study period were reviewed. Additional information provided by 3D-TEE (over 2D-TEE) was classified into the following: A: new information which changed/refined the plan and 0: no new important information. Pre- and post-bypass OR 3D-TEEs were counted as one study. A total of 67 3D-TEEs (41 Cath, 13 OR, and 13 EP procedures) were performed. Median age was 14 years (6–39 years). Median weight was 47 kg (21–109 kg). In Cath procedures, only 2/41 (5%) were graded A (R to L atrial level shunt [Fontan leak], n = 1; thrombus in pulmonary artery stump, n = 1). In the OR, 6/13 (46%) were graded A (atrioventricular valvuloplasty, n = 1; neo-aortic valvuloplasty, n = 1; relief of systemic and pulmonary venous outflow obstruction, n = 2 and n = 2; respectively). In EP procedures, 4/13 (31%) were graded A (thrombus, n = 3; mapping for lead placement to assist in multisite pacing for dyssynchrony, n = 1). 3D-TEE of Fontan improved visualization and frequently added value in the OR/EP lab and may be helpful in select catheterization cases. Future studies with a larger sample could build on this data to identify when 3D-TEE will be most useful. Keywords 3-Dimensional transesophageal echocardiography · 3D-TEE · Fontan · Interventional procedures · Congenital heart disease · Echocardiogram
Objectives
Introduction
The objective of this study was to evaluate the frequency in which information generated by three-dimensional transesophageal echocardiography (3D-TEE) added utility over two-dimensional transesophageal echocardiography (2D-TEE), changed long term management or refined procedures performed on patients post Fontan during cardiac catheterization (Cath), electrophysiology (EP) studies, and surgery in the operating room (OR).
For several decades, only 2D echocardiographic images of cardiovascular structures were available to cardiologists, electrophysiologists and surgeons. Even after post-processing technology enabled the formulation of 3D images from 2D datasets, the significant time required to produce 3D images hindered its usefulness during procedures. However, 3D imaging modalities have been developed that can advance echocardiographic guidance during complicated surgical or catheterization procedures, su
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